I sit in a chair much of my day, deeply listening, developing hypotheses for my patients’ behaviors, staying mentally “in the room” and managing my anxiety. I am fortunate in so many ways, but one of my great fortunes is that I love my job. You know those crazy people who don’t quit their jobs after winning the Powerball? That’s me. (For the record, I did not win the Powerball.)
So, here’s the dialectical: I love my job, and it’s really hard. I’m not asking for a medal or empathy. It’s just a fact: my job is hard. Not only am I responsible for actual lives, I have a role in my patients’ lives that I take very seriously: contributing to their health, relationships and meaning. When one does this type of work, it’s really, really important to know one’s self. (This is why therapists seek therapy and consultation from more experienced therapists.) My blind spots could contribute to a death. I wake up and fall asleep knowing this truth. I love this job, and it makes me anxious.
When I began my career as a therapist seven years after entering twice weekly therapy, my own, beloved therapist said to me, “If you can manage your anxiety in the room … it’s so important as a therapist.” I think of this insight day in and day out in my work. I cannot worry about what chores I neglected, the jury duty notice that I cannot find (!), my partner’s frustration with me, whether or not I paid the dog walker or if a healthier diet is vegan or paleo.
However, my greatest source of anxiety in the room is this: my patient’s discovering that I’m a “fraud”. Okay, let’s slow the truck down a bit. I’m not a fraud: I have the degree, licensure and ongoing trained required to do my work. This is anxiety: I fear that one day – and I don’t know when – the people whom I love the most and my patients for whom I care will discover just how much I suck. (For the record, I don’t suck, but it’s a fear.)
This fear of fraudulence is not pervasive. Rather, it’s one of those irksome fears that decides to pop up at the most inopportune times. A diabetic patient might discuss managing their blood sugars, and the fear of fraudulence finds its voice: “Do they notice the extra weight that I’m now carrying?” A patient might share their abuse of ETOH to cope with a family visit, and I empathize; I then recall how I reached for a beer at the end of a rough day. Another patient might discuss her eating to cope with stress as I feel my own shame over using sugar to reward myself after a tough session. Add up enough of these occurrences, and I have given my fear of fraudulence a megaphone. I fucking hate it. It’s awful.
I want to be a better human, partner and therapist. I want to be a healthcare provider who “walks the talk”. I want to muzzle my fear of fraudulence by following every recommendation that I make to my patients. I’m not going to lie: these changes are going to suck hard. AND (note my use of DBT there?) the changes will pay off. I truly believe it. I believe in me. I’m ready. Or not.